Getting Early Intervention Support at The ClementJames Centre

Thank you for taking the time to fill out this enquiry form. If you need support filling out this form, please contact reception@clementjames.org or give us a call on 020 7221 8810.

If you would like to discuss your case further before making a enquiry, please email earlyintervention@clementjames.org or give us a call on 020 7221 8810.

Please note:

The Early Intervention Support service is available to children and young people in Year 1 to Year 11, who either live in or attend a school in Kensington and Chelsea or Westminster.

We do not provide Early Intervention Support at an independent review panel stage.

This service is in high-demand and referrals will be prioritised based on level of need. You will usually get a response within one week from submitting your enquiry.

Privacy Notice

At The ClementJames Centre, we're committed to protecting and respecting your privacy.

Please see our privacy notice attached here, and tick here when you have read and agree to the terms laid out in it.

Who We Can Support

If your young person does not fit our criteria but you would like our help to find an organisation which can support them, please contact earlyintervention@clementjames.org or give us a call on 020 7221 8810.

Please select the borough your young person is a resident of, housed in or attends a school in:

We also have criteria that clients need to meet to access support. At least one of the following means that your young person is able to access support at the Centre.

Please select any of the following that apply to you:

Receiving benefits

Have a household income of less than £25,000

Living in social housing (this includes council, temporary accommodation and housing associations)

Child/ward receiving free school meals

Young Person's Details

First Name

Last Name

Date of Birth

Gender

Self-described gender:

Ethnicity

Self-described ethnicity:

Post Code

There are times when photographs of activities are taken for publicity and marketing purposes. This is really helpful for us to be able to show what we are doing in the community. Please tick here if you agree for your young person's image to be used in this way.

Your Details

Parent/Guardian Contact Number

Parent/Guardian Email

Please provide details of your young person's emergency contact:

Emergency Contact Full Name

Emergency Contact Telephone Number

How did you hear about this service?

Please tick here if you would like to be subscribed to our mailing list to hear about upcoming workshops, programmes, events and opportunities at The ClementJames Centre.

Young Person's Educational Information

The following information will allow us to offer appropriate support to your young person. Please give as much information as possible as this information will be used to prioritise enquiries.

Is the young person at risk of exclusion or have they already been excluded?

The young person is at risk of exclusion with an accumulation of behaviour points

The young person is at a high risk of exclusion having received final warnings and the prospect of suspension is being discussed

The young person has been excluded

Please provide details of your young person's Early Intervention needs, including as much information as possible in relation to their exclusion:

Please provide details of your young person's Early Intervention needs, including as much information as possible in relation to them being at risk of exclusion:

Please provide details of your young person's Early Intervention needs, including as much information as possible in relation to them being at a high risk of exclusion:

Educational Information Continued

Which school year is the young person in?

What school does the young person attend? (Only complete if the child is currently attending Primary School.)

What school does the young person attend? (Only complete if the child is currently attending Secondary School.)

Does the young person have a diagnosis or are they awaiting a diagnosis for SEN (Special Educational Needs)?

Awaiting SEN diagnosisSEN diagnosis

Please can you provide us with more details:

Does the young person have or are they awaiting an EHCP (an education, health and care plan)?

Awaiting EHCPEHCP in place

Please can you provide us with more details:

Was/is the young person in a mainstream school?

Please can you provide us with more details:

Does the young person have experience with the Youth Justice System?

Please can you provide us with more details:

Accessibility Needs

Do you or your young person have any physical accessibility needs that we should know about?

Please provide us with more details:

Please tick here if you or your young person will need assistance to exit the building in the event of an emergency evacuation. Staff will prepare a Personal Emergency Evacuation Plan (PEEP) for you / your young person.

Professional Involvement

Are there any other professionals involved in your young person's case? (Please select all that apply):

Other:

Contact Details

If they consent to their contact details being shared with us, please provide details for the primary professional you are working with below:

Full Name

Role

Email

Contact Number

Submit Your Form

Please submit the form below.